Accounting for Twins and Other Multiple Births in Perinatal Studies of Live Births Conducted Using Healthcare Administration Data.

IF 4.7 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Epidemiology Pub Date : 2025-03-01 Epub Date: 2024-11-13 DOI:10.1097/EDE.0000000000001809
Jeremy P Brown, Jennifer J Yland, Paige L Williams, Krista F Huybrechts, Sonia Hernández-Díaz
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引用次数: 0

Abstract

The analysis of perinatal studies is complicated by twins and other multiple births even when multiples are not the exposure, outcome, or a confounder of interest. In analyses of infant outcomes restricted to live births, common approaches to handling multiples include restriction to singletons, counting outcomes at the pregnancy level (i.e., by counting if at least one twin experienced a binary outcome), or infant-level analysis including all infants and accounting for clustering of outcomes, such as by using generalized estimating equations or mixed effects models. Several healthcare administration databases only support restriction to singletons or pregnancy-level approaches. For example, in MarketScan insurance claims data, diagnoses in twins are often assigned to a single infant identifier, thereby preventing ascertainment of infant-level outcomes among multiples. Different approaches correspond to different questions, produce different estimands, and often rely on different assumptions. We demonstrate the differences that can arise from these different approaches using Monte Carlo simulations, algebraic formulas, and an applied example.

围产期研究的分析因双胞胎和其他多胞胎而变得复杂,即使多胞胎不是暴露、结果或感兴趣的混杂因素。在对限于活产的婴儿结果的分析中,处理多胎的常用方法包括限制单胎,在妊娠水平上计算结果(即,通过计算是否至少有一个双胞胎经历了二元结果),或包括所有婴儿的婴儿水平分析并考虑结果的聚类,例如通过使用广义估计方程或混合效应模型。一些医疗保健管理数据库仅支持对单胎或妊娠级方法的限制。例如,在MarketScan保险索赔数据中,双胞胎的诊断通常分配给单个婴儿标识符,从而无法确定多个婴儿的婴儿水平结果。不同的方法对应不同的问题,产生不同的估计,并且通常依赖于不同的假设。我们使用蒙特卡罗模拟、代数公式和一个应用示例来演示这些不同方法可能产生的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Epidemiology
Epidemiology 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.70
自引率
3.70%
发文量
177
审稿时长
6-12 weeks
期刊介绍: Epidemiology publishes original research from all fields of epidemiology. The journal also welcomes review articles and meta-analyses, novel hypotheses, descriptions and applications of new methods, and discussions of research theory or public health policy. We give special consideration to papers from developing countries.
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